Estimating normal lung weight measurement using postmortem CT in forensic cases

Matoba, Kotaro; Hyodoh, Hideki; Murakami, Manabu; Saito, Atsuko; Matoba, Tomoko; Ishida, Lisa; Fujita, Emi; Yamase, Mayumi; Jin, Shigeki

doi:10.1016/j.legalmed.2017.10.014

Cited by 12 publications

(10 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Average lung weights [3, 9, 21-26] were plotted on MATLAB (MathWorks, Natick, MA, USA) and Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). A one-way Analysis of Variance (ANOVA) coupled with a post-hoc analysis was performed using a Tukey Honestly Significant Difference (HSD) test.…”

Section: Resultsmentioning

confidence: 99%

“…The goal of an autopsy is to discover the cause of death (COD) using a macro/microscopic investigation. Because lung weight is often affected by the cause of death and the last breath occurs very near if not at death, the evaluation of the lungs is one of the starting points of any COD investigation [3] . A comprehensive search was performed to systematically review all reported autopsy findings in COVID-19 patients with respect to lung weights and histologic findings.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

Mong

Awkal

Marik

2020

Preprint

View full text Add to dashboard Cite

Background To date, more than 161,000 people have died from the coronavirus disease 2019 (COVID-19) yet the fundamental drivers of the morbidity and mortality remain uncertain. Clinicians worldwide appear to be at a loss to know how to prevent and treat the severe respiratory distress in these patients effectively. Consequently, the fundamental mechanisms leading to death in high-risk patients with COVID-19 need to be discovered and addressed with urgency. Despite a marked drop in frequency, the post-mortem autopsy remains an essential part of both discovering the cause of death in a particular individual, but also in advancing the science and treatment of disease, especially in the case of novel pathogens such as SARS-CoV-2[2]. The goal of an autopsy is to discover the cause of death (COD) using a macro/microscopic investigation. Traditionally, the intact organs are carefully removed, inspected, and weighed. Because lung weight is often affected by the cause of death and the last breath occurs very near if not at the moments of death, the evaluation of the lungs is one of the starting points of any COD investigation[3]. Method A comprehensive search was performed to systematically review all reported autopsy findings in COVID-19 patients in order to better understand the underlying disease mechanisms resulting in death. We then compared these findings with the results of a targeted literature review of hyaluronan in relationship to acute respiratory distress syndrome (ARDS). Results In total, data from 181 autopsies were identified. From this group, 6 autopsies of COVID-19 patients were selected for a detailed review and statistical analysis. The average lung weight of those who were determined to have died as a result of SARS-CoV-2 was 2196g-approximately 2.5x normal lung weight. Hyaline membranes were consistently identified on histologic sections. A review of the literature reveals that hyaluronan has been associated with the pathophysiology of ARDS since 1967. However, its key role in driving the morbidity and mortality of the condition has heretofore not been fully recognized. Conclusions We propose that the induced hyaluronan storm syndrome or IHS, is the model that best addresses the heretofore perplexing respiratory failure that is the proximal cause of death in a minority, but ever rising number, of patients. In addition to treating and preventing IHS in currently infected individuals now; an aggressive research effort should be undertaken to discover why the majority of individuals who are exposed to the virus are either minimally or asymptomatic, while a minority of high-risk individuals rapidly progress to respiratory failure and death. Keywords Systematic review; COVID-19; SARS-CoV-2; Hyaline Membrane; Hyaluronan; Acute Respiratory Distress Syndrome; ARDS; Autopsy; IHS; Induced Hyaluronan Storm Syndrome; COD; Cause of Death

show abstract

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

Mong

Awkal

Marik

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This might partially explain why unilateral right lung pathology is often clinically more severe than unilateral left, such as in right-sided CDH which has been associated with greater long-term morbidity ( 14 ), although clearly other factors might also play a role such as that the liver, which is herniating in right-sided CDH, is a non-compressible organ. In children and young adults, the volume of the right lung has been reported as 1.12 times larger than the volume of the left lung ( 15 ) and the weight as 1.14 times larger ( 16 ) but the projection of a three-dimensional structure to a two-dimensional radiograph might explain this discrepancy.…”

Section: Discussionmentioning

confidence: 98%

Brief research report: Chest radiographic thoracic area in term ventilated infants without respiratory disease

Dassios

Adu²,

Greenough³

2023

Front. Pediatr.

View full text Add to dashboard Cite

ObjectiveTo report values of the chest radiographic thoracic area (CRTA) in ventilated, term-born infants without respiratory disease and to evaluate whether CRTA is related to demographic data at birth.MethodsRetrospective, observational cohort study in a tertiary neonatal unit at King's College Hospital NHS Foundation Trust, London, UK.Newborn infants born after 36 completed weeks of gestation, ventilated for poor perinatal adaptation or hypoxic ischaemic encephalopathy without respiratory disease and admitted in a recent eight-year period (2014–2022).The CRTA was assessed by free-hand tracing of the perimeter of the thoracic area as outlined by the diaphragm and the rib cage excluding the mediastinal structures and was calculated using the Sectra PACS software.ResultsOne hundred and twenty-one infants (75 male) were included with a median (IQR) gestation of 40 (38–41) weeks and birth weight of 3.41 (3.04–3.75) kg. The median (IQR) CRTA was 2,589 (2,167–2,943) mm2 and was significantly related to birth weight (r = 0.316, p = 0.003), gestation at birth (r = 0.193, p = 0.032) and birth weight z-score (r = 0.187, p = 0.038).ConclusionsWe report values of the chest radiographic thoracic area in ventilated term-born infants which could be used as reference for determining respiratory disease severity.

show abstract

“…The CAD curve displayed a bimodal distribution after a rapid rise, but only one peak was found in drowning. In a previous report, the CT value range, from −1 000 to −700 HU, was used to assess the normal aerated lung [ 20 ]. Compared with the normal aerated lung, the lung CT value increased both in drowning and control group.…”

Section: Discussionmentioning

confidence: 99%

Postmortem chest computed tomography for the diagnosis of drowning: a feasibility study

Jian

Lee

Shao

et al. 2019

Forensic Sciences Research

View full text Add to dashboard Cite

It may be difficult to distinguish the cause of death in drowning cases without specific findings. The aim of this study was to explore the forensic value of thoracic postmortem computed tomography (PMCT) using routine images and three-dimensional (3D) image reconstructions. The imaging data of PMCT examinations of six drowning cadavers, aged 21-54 years, were analyzed. Twelve victims of sudden death from coronary artery disease (CAD) were chosen as a control group. After 3D bilateral lung images were reconstructed using image processing software, an interactive medical image control system was used to measure and analyze parameters including lung volume, lung volume ratio, mean CT value of the whole lung, and lung CT value distribution curves. Lung volume and lung volume ratio were used to assess the shape changes of the lung. Lung CT value distribution curves showed the corresponding number of pixels of the different CT values in the lung image. Lung volume was not significantly larger in drowning cases (mean 2 958 cm 3 ) than in controls (mean 2 342 cm 3 ). Lung volume ratio values in the drowning group (mean 0.3156) were greater than that in the control group (mean 0.2763); (P ¼ 0.02). There was no significant difference between the drowning and control group in the mean CT value of the whole lung. There were differences between lung CT value distribution curves in drowning victims and controls, with drowning victims showing a single peak and CAD cases showing a bimodal distribution. Thoracic PMCT is helpful for the forensic medical diagnosis of drowning. Lung volume ratio and lung CT value distribution are potential indicators to distinguish between drowning and CAD. ARTICLE HISTORY

show abstract

Estimating normal lung weight measurement using postmortem CT in forensic cases

Abstract: The well aerated lung weight was 284.9 ± 14.8 g in right lung and 249.3 ± 12.9 g in left lung, and the postmortem CT could estimate the lung weight with high correlation coefficient.

Cited by 12 publications

References 20 publications

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

Brief research report: Chest radiographic thoracic area in term ventilated infants without respiratory disease

Postmortem chest computed tomography for the diagnosis of drowning: a feasibility study

Contact Info

Product

Resources

About

Estimating normal lung weight measurement using postmortem CT in forensic cases

Abstract: The well aerated lung weight was 284.9 ± 14.8 g in right lung and 249.3 ± 12.9 g in left lung, and the postmortem CT could estimate the lung weight with high correlation coefficient.

Cited by 12 publications

References 20 publications

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

Brief research report: Chest radiographic thoracic area in term ventilated infants without respiratory disease

Postmortem chest computed tomography for the diagnosis of drowning: a feasibility study

Contact Info

Product

Resources

About

Abstract: The well aerated lung weight was 284.9 ± 14.8 g in right lung and 249.3 ± 12.9 g in left lung, and the postmortem CT could estimate the lung weight with high correlation coefficient.